Comprehensive visualization of the pubocervical and rectovaginal fasciae in post-hysterectomy prolapse: magnetic resonance imaging and intraoperative diaphanoscopy
Melnik P.S., Olimpov B.P., Aryutin D.G.
Background. Post-hysterectomy apical prolapse is frequently associated with pelvic floor fascial defects; however, preoperative visualization remains challenging.
Objective. To assess the agreement and diagnostic comparability between magnetic resonance imaging (MRI) findings and intraoperative observations and to determine the clinical value of their combined use for optimizing surgical management and improving postoperative outcomes.
Materials and methods. This prospective observational study included 59 patients with vaginal vault prolapse after total hysterectomy. All patients underwent pelvic MRI to evaluate the pubocervical and rectovaginal fasciae. Intraoperative diaphanoscopy was used to visualize the fascial defects during reconstructive surgery. MRI findings were compared with intraoperative observations, and the reproducibility of the quantitative measurements was analyzed.
Results. MRI identified fascial defects in all patients. The pubocervical fascia most commonly exhibited anterolateral and medial defects, whereas the rectovaginal fascia most often demonstrated mid-posterior compartment involvement. Defect localization on MRI corresponded to that identified by diaphanoscopy in most cases; quantitative assessment of defect extent showed high reproducibility between the two methods.
Conclusion. The combined use of MRI and intraoperative diaphanoscopy enables a comprehensive assessment of pelvic floor fascial defects and helps optimize the strategy for reconstructive surgery for post-hysterectomy apical prolapse.
Authors' contributions. Melnik P.S. – conception and design of the study, collection and processing of clinical material, participation in MRI and intraoperative data analysis, statistical analysis, drafting of the manuscript, editing and preparation of the final version of the manuscript; Olimov B.P. – performance of MRI studies, interpretation of MRI images, participation in the formation of the visualization protocol, critical revision of the manuscript; Aryutin D.G. – scientific supervision, consulting on study design, clinical expert evaluation of results, editing of the manuscript, approval of the final version for submission.
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.
Ethical Approval. The study was reviewed and approved by the Research Ethics Committee of the City Clinical Hospital No. 29 named after N.E. Bauman, Moscow Healthcare Department (Ref. No: 04/25 of 01.12.2025).
Patient Consent for Publication. All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Melnik P.S., Olimpov B.P., Aryutin D.G. Comprehensive visualization of the pubocervical and rectovaginal fasciae in post-hysterectomy prolapse: magnetic resonance imaging and intraoperative diaphanoscopy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (5): 89-98 (in Russian)
https://dx.doi.org/10.18565/aig.2025.359
Keywords
apical prolapse
post-hysterectomy prolapse
pelvic fasciae
pelvic floor MRI
intraoperative diaphanoscopy
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Received 07.12.2025
Accepted 24.03.2026
About the Authors
Polina S. Melnik, obstetrician-gynecologist, Gynecological Department, City Clinical Hospital No. 29 named after N.E. Bauman, Moscow Healthcare Department,111020, Russia, Moscow, Gospitalnaya sqr., 2, +7(906)770-35-68, Pomelya97@mail.ru, eLibrary SPIN: 4504-3978; https://orcid.org/0000-0002-5998-1494
Bekhruz P. Olimov, PhD, Radiology Department, City Clinical Hospital No. 29 named after N.E. Bauman, Moscow Healthcare Department, 111020, Russia, Moscow, Gospitalnaya sqr., 2, +7(966)328-12-18, Alimovbp90@gmail.com, https://orcid.org/0000-0003-3532-8201
Dmitrii G. Aryutin, PhD, Associate Professor, Department of Obstetrics, Gynecology with a Course of Perinatology, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow; Head of Gynecological Department, City Clinical Hospital No. 29 named after N.E. Bauman, Moscow Healthcare Department, 111020, Russia, Moscow, Gospitalnaya sqr., 2, Aryutin@mail.ru, eLibrary SPIN: 8235-5040, https://orcid.org/0000-0003-0258-8445
Corresponding author: Polina S. Melnik, Pomelya97@mail.ru
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